Intervention and Procedure
All participants received their routine rehabilitation according to the daily inpatient treatment program schedule during the study periods. The participants in the NTT group were familiarized with Nordic walking on the treadmill. Familiarization was implemented for approximately 15 minutes/day and was completed for 1-3 days depending on the participants. The familiarization period ended when the participant was able to maintain the Nordic walking on the treadmill for 5 minutes. All of the participants in the NTT group were comfortable after the familiarization period.
During TT, both hands were fixed to the handle of the machine by using a bandage during gait training. Treadmill speed was adjusted in the range of participant’s appropriate speed 1~4 km/hour. During NTT, the hands of the participants
were stabilized to the pole (diameter: 3.5 cm, length: 148 cm) and the therapist guided both hands of each participant (Fig. 1). The therapist helped that crossed to the upper and lower extremity at appropriate time as according to verbal cue. Treadmill speed was adjusted in the range of the participants’ appropriate speed 1 ~ 4 km/hour and affected side hand gripped the pole using the elastic bandage. Arm swing during walking was performed from 20 to 40 times per minute and swing angle was within 15° flexion and extension. Some of the verbal cues were as follows: providing maximum bearable load on the stance leg, maintaining upright extended trunk and head, facilitation reciprocal arm swing and escaping weight bearing on the arms, and facilitating balanced interlimb coordination. The participants wore lightweight shoes with high-cut ankles and thin soles during training to maximize cutaneous stimulation from the sole of the foot in the stance phase. Both types of training were applied 30 minutes/day, 5 times a week for 6 weeks. All trainings were conducted under supervision by a therapist for the patients’ safety.
Statistical Analysis
PASW Statistics 18 software (SPSS Inc., Chicago, IL) was used to perform all statistical analyses. Descriptive and analytical statistics are presented. Data were presented as mean and standard deviation. Normality was examined using a 1-sample Kolmogorov–Smirnov test. Independent t-tests were used to compare differences between group means and paired t-tests were used to compare within group means. Statistical significance was set at a P value less than .05.